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Systematic Review

Implementing a hospital guideline on pneumonia: a semi-quantitative review.

Cortoos PJ, Simoens S, Peetermans W, Willems L, Laekeman G. Implementing a hospital guideline on pneumonia: a semi-quantitative review. International Journal for Quality in Health Care 2007 19 (6):358-67. [PubMed]

Sources of funding: Not stated. Conflict of interest not stated.

Main author affiliation: Cortoos PJ, Katholieke Universiteit Leuven, Leuven, Belgium.

Q: What are methods of classifying used CAP guideline implementation interventions and their intensity of use on several processes of care, clinical, and/or economic outcomes?

BACKGROUND

This review considered interventions that evaluated the effect of guidelines on compliance of care processes and the clinical or economic outcomes in the treatment of community-acquired pneumonia. Professional interventions include educational meetings; distribution of educational materials; audit and feedback; local opinion leaders; reminders; and other and multifaceted interventions.

INCLUSION

Individual studies from systematic review

SEARCH FOR EVIDENCE: Up to Mar 2006.

INCLUDED STUDIES: 27 studies (30 papers)

STUDIES RELATED TO PRESCRIBING: 23

STUDY DESIGN: BA, CBA, RCT.

STUDY CHARACTERISTICS:

  • Target Population: Physicians, Pharmacists, Nurses, Other (Microbiologists).
  • Intervention(s): Multifaceted, Educational meetings, Organisational (provider) — other.
  • Setting: Hospitals, Primary care practices, Not specified/Unclear.
  • Patients Reviewed: Age: Adults, Elderly; Diagnosis/Clinical condition: Pneumonia.
  • Drug Related Outcome Categories: Appropriate use, Choice, Route of administration.
  • Other Outcome Categories: Appropriate care, Procedures, Test ordering, Referrals, Other resource use.

AUTHORS' ANALYSIS OF DATA:

Range of effects.

REVIEW QUALITY: 5

RESULTS - OVERALL

Of included studies, 3 were RCTs. Multifaceted interventions yielded generally effective results for appropriate care (n=25).

RESULTS - RELATED TO PRESCRIBING

Multifaceted interventions demonstrated generally effective results for appropriate use (n=10), appropriate use — choice (n=12), and appropriate use — route of administration (n=7).There was insufficient evidence to assess to effects of educational meetings (n=1) on appropriate use — route of administration, and organisational interventions (n=1) on appropriate use.

CONCLUSIONS - OVERALL

Medium quality review. Multifaceted interventions were found to be effective for improving appropriate care.

CONCLUSIONS - RELATED TO PRESCRIBING

Medium quality review. Multifaceted interventions were found to be effective for improving the following prescribing behaviours: appropriate use, appropriate use — choice, and appropriate use — route of administration.


Table of Results

Comparison Outcome N Analysis Results
Organisational vs control Appropriate care 1 Vote counting based on direction of effect Vote counting 1/1 study favoured intervention: insufficient evidence.

Prescribing related outcomes:
Other appropriate use:
Vote counting 1/1 study favoured intervention: insufficient evidence.
Educational meetings vs control Appropriate care 1 Vote counting based on direction of effect Vote counting 1/1 study favoured intervention: insufficient evidence.

Prescribing related outcomes:
Route of administration:
Vote counting 1/1 study favoured intervention: insufficient evidence.
Multifaceted vs control Appropriate care 25 Vote counting based on direction of effect Vote counting 23/25 studies (mixed designs) favoured intervention: generally effective.
3/3 RCTs favoured intervention: generally effective.

Prescribing related outcomes:
Other appropriate use:
Vote counting 8/10 studies (mixed designs) favoured intervention: generally effective.

Choice:
Vote counting 12/12 studies (mixed designs) favoured intervention: generally effective.
1/1 RCT favoured intervention: insufficient evidence.

Route of administration:
Vote counting 6/7 studies (mixed designs) favoured intervention: generally effective.
3/3 RCTs favoured intervention: generally effective.